Optimum palliation of inoperable hilar cholangiocarcinoma: comparative assessment of the efficacy of plastic and self-expanding metal stents.

Abstract

BACKGROUND:

Endoscopic retrograde biliary drainage (ERBD) with plastic or self-expanding metal stents (SEMS) is often performed for palliative care for cholangiocarcinoma.

OBJECTIVE:

The objective was to compare the clinical effectiveness, including stent patency, complication rate, and need for salvage percutaneous transhepatic biliary drainage, of SEMS and plastic stents.

METHODS:

A total of 100 patients with inoperable cholangiocarcinoma were identified from an endoscopic database from 1/1/01 to 9/30/06 at a tertiary cancer hospital and their clinical history was retrospectively reviewed. All patients were followed to death, re-intervention, or for at least one year. Stent patency and patient survival were estimated by Kaplan-Meier analysis, supplemented by the log-rank test for comparisons between groups.

RESULTS:

Forty-eight patients had SEMS placed and 52 patients had plastic stents placed. ERBD was successful in 46 (95.8%) in the SEMS group and 49 (94.2%) in the plastic group (P = 0.67). Median patency times were 1.86 months in the plastic group and 5.56 months in the SEMS group (P < 0.0001). A mean of 1.53 and 4.60 re-interventions were performed in the SEMS and plastic groups, respectively (P < 0.05). Complications occurred in 4/48 (8.3%) in the SEMS group and 4/52 (7.7%) in the plastic group (P = 0.79). Median survival was 9.08 and 8.22 months in the SEMS and plastic stent groups, respectively (P = 0.50).

CONCLUSION:

Metallic stent patency was superior to that of plastic stents in all Bismuth-Corlette classifications of hilar cholangiocarcinoma with similar complication rates. SEMS seem to be cost-effective and, when feasible, should be considered as an initial intervention in patients with inoperable hilar cholangiocarcinoma.

• Authors: Ramu P Raju, Sathya R Jaganmohan, William A Ross, Marta L Davila, Milind Javle, Gottumukkala S Raju, Jeffrey H Lee
• Journal: Digestive diseases and sciences (Dig Dis Sci) Vol. 56 Issue 5 Pg. 1557-64 (May 2011) ISSN: 1573-2568 [Electronic] United States
• PMID: 21222156 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Metals
• Plastics

Topics

• Adult
• Aged
• Aged, 80 and over
• Bile Duct Neoplasms (mortality, surgery)
• Bile Ducts, Intrahepatic
• Cholangiocarcinoma (mortality, surgery)
• Female
• Humans
• Male
• Metals
• Middle Aged
• Palliative Care
• Plastics
• Retrospective Studies
• Stents (classification)
• Young Adult